Volume 63, Issue 8 pp. 2037-2055
RESEARCH ARTICLE

Patient-specific structural connectivity informs outcomes of responsive neurostimulation for temporal lobe epilepsy

Chantel M. Charlebois

Chantel M. Charlebois

Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA

Scientific Computing & Imaging Institute, University of Utah, Salt Lake City, Utah, USA

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Daria Nesterovich Anderson

Daria Nesterovich Anderson

Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA

Department of Pharmacology & Toxicology, University of Utah, Salt Lake City, Utah, USA

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Kara A. Johnson

Kara A. Johnson

Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA

Department of Neurology, University of Florida, Gainesville, Florida, USA

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Brian J. Philip

Brian J. Philip

Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA

Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA

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Tyler S. Davis

Tyler S. Davis

Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA

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Blake J. Newman

Blake J. Newman

Department of Neurology, University of Utah, Salt Lake City, Utah, USA

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Angela Y. Peters

Angela Y. Peters

Department of Neurology, University of Utah, Salt Lake City, Utah, USA

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Amir M. Arain

Amir M. Arain

Department of Neurology, University of Utah, Salt Lake City, Utah, USA

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Alan D. Dorval

Alan D. Dorval

Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA

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John D. Rolston

John D. Rolston

Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA

Scientific Computing & Imaging Institute, University of Utah, Salt Lake City, Utah, USA

Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA

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Christopher R. Butson

Corresponding Author

Christopher R. Butson

Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA

Department of Neurology, University of Florida, Gainesville, Florida, USA

Department of Neurosurgery, University of Florida, Gainesville, Florida, USA

Department of Biomedical Engineering, University of Florida, Gainesville, Florida, USA

Correspondence

Christopher R. Butson, Fixel Institute, University of Florida, Gainesville, FL, USA.

Email: [email protected]

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First published: 13 May 2022
Citations: 5

Abstract

Objective

Responsive neurostimulation is an effective therapy for patients with refractory mesial temporal lobe epilepsy. However, clinical outcomes are variable, few patients become seizure-free, and the optimal stimulation location is currently undefined. The aim of this study was to quantify responsive neurostimulation in the mesial temporal lobe, identify stimulation-dependent networks associated with seizure reduction, and determine if stimulation location or stimulation-dependent networks inform outcomes.

Methods

We modeled patient-specific volumes of tissue activated and created probabilistic stimulation maps of local regions of stimulation across a retrospective cohort of 22 patients with mesial temporal lobe epilepsy. We then mapped the network stimulation effects by seeding tractography from the volume of tissue activated with both patient-specific and normative diffusion-weighted imaging. We identified networks associated with seizure reduction across patients using the patient-specific tractography maps and then predicted seizure reduction across the cohort.

Results

Patient-specific stimulation-dependent connectivity was correlated with responsive neurostimulation effectiveness after cross-validation (p = .03); however, normative connectivity derived from healthy subjects was not (p = .44). Increased connectivity from the volume of tissue activated to the medial prefrontal cortex, cingulate cortex, and precuneus was associated with greater seizure reduction.

Significance

Overall, our results suggest that the therapeutic effect of responsive neurostimulation may be mediated by specific networks connected to the volume of tissue activated. In addition, patient-specific tractography was required to identify structural networks correlated with outcomes. It is therefore likely that altered connectivity in patients with epilepsy may be associated with the therapeutic effect and that utilizing patient-specific imaging could be important for future studies. The structural networks identified here may be utilized to target stimulation in the mesial temporal lobe and to improve seizure reduction for patients treated with responsive neurostimulation.

CONFLICT OF INTEREST

AMA has served as a consultant for NeuroPace. JDR has served as a consultant for Medtronic, NeuroPace, and Corlieve Therapeutics. CRB has recently served as a consultant for NeuraModix and Abbott and holds intellectual property related to neuromodulation therapy. The remaining authors have no conflicts of interest.

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